LEA Clinical of the Leg

Question 1

Common Fibular Nerve

Answer 1

• From sciatic nerve

- Passes around fibular neck

Question 2

Common Fibular Nerve enters lateral compartment by

Answer 2

passing through posterior intermuscular septum

Question 3

common fibular nerve bifurcates into what terminal branches

Answer 3

deep fibular

superficial fibular

Question 4

deep fibular nerve passes through

Answer 4

anterior intermuscular septum to enter anterior compartment

Question 5

common fibular nerve is susceptible to injury

Answer 5

• as it passes around fibula
• prolonged compression (from tight cast, sitting/sleeping position)
• trauma

Question 6

injury to the common fibular is associated with

Answer 6

• Footdrop (increased tripping with gait) (b/c deep fibular)
• Weak dorsiflexion, toe extension, eversion
• Steppage gait
• Loss of sensation, distal anterolateral leg, dorsum of foot, 1st web space

Question 7

broken fibula causes damage to

Answer 7

peroneal nerve (common fibular)

Question 8

Which of the following have a footdrop associated with weakness with dorsiflexion?
Common fibular nerve lesion?
Deep fibular nerve lesion?
Superficial nerve lesion?
Sciatic nerve lesion?
L4 spinal nerve lesion?

Answer 8

Common Fibular- yes
Deep Fibular- yes
Sciatic Nerve- yes
L4 Spinal nerve- yes
NOT Superficial nerve lesion.

Question 9

Transmalleolar axis

Answer 9

Line passing between the center of the medial and lateral malleoli
relation to line passing through knee joint axis

Question 10

Transmalleolar axis measures

Answer 10

tibial torsion

Question 11

normal tibial torsion

Answer 11

children: -10 - 0 degrees
infants more negative, more internal rotation
Adults (reached by 8-10 yrs): 10-15 degrees external rotation

Question 12

can obtain tibial torsion by measuring transmalleolar angle

Answer 12

Patient prone.
Line through the longitudinal axis of the thigh
and a line perpendicular to the most prominent point of the malleoli.

Question 13

obtain tibial torsion by using thigh foot angle

Answer 13

Patient prone. Line bisecting foot and line bisecting thigh

Question 14

Kager Triangle

Answer 14

Radiolucent (dark) triangle seen on lateral radiographs

Question 15

Kagar Fat Pad

Answer 15

pre calcaneal, pre achilles fat pad

Question 16

Obliterated Kager triangle

Answer 16

• Achilles pathology (tearing, inflammation)
• Calcaneal frx
• FHL tendon pathology
• Accessory soleus muscle

Question 17

Boundaries of tarsal tunnel

Answer 17

• Medial: flexor retinaculum (laciniate ligament) and abductor hallucis
• Lateral: calcaneus, posterior talotibial and calcaneotibial ligaments
• Porta pedis is the distal margin of the tunnel

Question 18

the porta pedis is the distal margin of

Answer 18

the tarsal tunnel

Question 19

Tarsal Tunnel Syndrome

Answer 19

• Compressive neuropathy of tibial nerve or its branches within the tarsal tunnel
• porta pedis is also an entrapment site

Question 20

tarsal tunnel syndrome causes altered sensation and pain over

Answer 20

medial and plantar foot, medial ankle (tibial nerve distribution)

Question 21

tarsal tunnel syndrome can cause _____ with prolonged compression

Answer 21

Atrophy of intrinsic foot muscles

Question 22

Tinel sign

Answer 22

• is present with tarsal tunnel syndrome

- pain with tapping, percussing the nerve in tunnel

Question 23

Symptoms of tarsal tunnel syndrome reproduced with

Answer 23

sustained dorsiflexion of ankle and MTPJs and eversion of ankle;
Also can be reproduced with sustained plantarflexion and inversion.

Question 24

treatment of tarsal tunnel syndrome

Answer 24

conservatively or surgically

Question 25

Ankle Blocks

Answer 25

Used for procedures of the foot, pain relief, when a more local is not possible, etc

Question 26

Ankle blocks avoid

Answer 26

- general anesthesia - motor block of the leg muscles and sensory of the leg - avoid releasing anesthesia into vessels, avoid puncturing nerves (anesthesia is released around the nerve)

Question 27

landmarks are key with ankle blocks so ____ can be used to help

Answer 27

- ultrasounds | - nerve stimulators

Question 28

Most of the foot is innervated by

Answer 28

nerves derived from the sciatic nerve, except 1 (saphenous)

Question 29

5 nerves located at the ankle provide

Answer 29

- sensory innervation to the foot | - 3 superficial and 2 deep

Question 30

3 superficial sensory nerves to the foot

Answer 30

1. saphenous 2. sural 3. superficial fibular

Question 31

2 deep sensory nerves to the foot

Answer 31

1. posterior tibial | 2. deep fibular

Question 32

Posterior tibial nerve block | via the medial calcaneal branches, medial plantar, lateral plantar nerves

Answer 32

Plantar foot, medial heel, toe tips

Question 33

sural nerve block

Answer 33

Lateral ankle, lateral heel, lateral foot, lateral 5th digit

Question 34

deep fibular nerve block

Answer 34

1st web space

Question 35

superficial fibular nerve block

Answer 35

most of the dorsum of the foot and toes

Question 36

saphenous nerve block

Answer 36

medial foot

Question 37

at the level of the malleoli which nerves are subcutaneous and which are deep to retinacula

Answer 37

-Saphenous, superficial fibular, sural are subcutaneous -Deep fibular and posterior tibial are deep and become more superficial distally) [-Where they are blocked depends on procedure]

Question 38

Deep fibular nerve

Answer 38

deeply located at the ankle deep to deep fascia

Question 39

landmarks of the deep fibular nerve

Answer 39

EHL, EDL, TA tendons, medial malleolus

Question 40

perimalleolar: deep fibular nerve

Answer 40

lateral to EHL, | level of the superior aspect of medial malleolus

Question 41

mid tarsal: deep fibular nerve

Answer 41

lateral to EHL, medial to dorsalis pedis artery pulse

Question 42

Superficial fibular nerve landmarks

Answer 42

Subcutaneous between lateral malleolus and EHL tendon

Question 43

perimalleolar: Superficial fibular nerve

Answer 43

between superior aspect of lateral malleolus and EHL | Anesthesia is administered in the area between the 2 landmarks

Question 44

Perimalleolar: Sural Nerve

Answer 44

Subcutaneous, between Achilles tendon and superior aspect of lateral malleolus (Anesthesia is administered between the 2 landmarks)

Question 45

Perimalleolar: Posterior Tibial nerve

Answer 45

deep to the deep fascia, posterior to medial malleolus

Question 46

Posterior Tibial Nerve is posterior to posterior tibial pulse where ?

Answer 46

midway between superior aspect of medial malleolus and Achilles tendon

Question 47

Perimalleolar: Saphenous Nerve

Answer 47

subcutaneous | between TA tendon and medial malleolus

Question 48

During a saphenous Nerve block ___ is nearby and can be punctured easily

Answer 48

Saphenous vein

Question 49

body and sustentaculum tali

Answer 49

Tibia, talus, calcaneus